Table 2.
Echocardiographic Results in CCS, Grouped by Cardiotoxic Exposures, and Sibling Control Subjects
| Childhood Cancer Survivors |
Siblings |
||||||
|---|---|---|---|---|---|---|---|
| Only Anthracyclines/Mitoxantrone (n = 839a) | Only RT to Heart Region (n = 152) | RT to Heart Region and Anthracyclines/Mitoxantrone (n = 260a) | Potentially Cardiotoxic Therapyb (n= 143) | P Value Among CCS Groups | Siblings (n = 277) | P Value CCS vs Siblings | |
| Primary outcomes | |||||||
| Abnormal LV ejection fraction | 171 (22) | 32 (23) | 87 (38) | 17 (13) | <0.001 | 14 (5.2) | <0.001 |
| Missing | 66 | 13 | 30 | 16 | 10 | ||
| Abnormal LV global longitudinal strain | 175 (26) | 46 (38) | 84 (41) | 29 (26) | <0.001 | 27 (10.6) | <0.001 |
| Missing | 160 | 30 | 54 | 30 | 23 | ||
| Abnormal LV ejection fraction + LV global longitudinal strain | 89 (13) | 16 (13) | 43 (22) | 9 (8.3) | 0.008 | 5 (2.0) | <0.001 |
| Missing | 168 | 33 | 60 | 34 | 25 | ||
| LV diastolic dysfunction ≥grade II | 4 (0.5) | 2 (1.4) | 7 (2.9) | 1 (0.8) | 0.014 | 0 (0) | 0.15 |
| Missing/indeterminate | 33 | 8 | 18 | 11 | 3 | ||
| Secondary outcomes | |||||||
| LV ejection fraction, % | 56.2 ± 6.0 | 56.3 ± 5.1 | 54.2 ± 6.1 | 58.6 ± 4.8 | <0.001 | 59.6 ± 3.8 | <0.001 |
| LV global longitudinal strain, % | −18.4 ± 2.4 | −18.0 ± 2.2 | −17.6 ± 2.4 | −18.9 ± 2.4 | <0.001 | −20.1 ± 2.1 | <0.001 |
| Mid-LV global circumferential strain, % | −19.1 ± 3.4 | −19.5 ± 3.5 | −17.4 ± 3.5 | −21.4 ± 3.2 | <0.001 | −21.2 ± 3.1 | <0.001 |
| LV lateral e′, cm/s | 15 ± 4 | 12 ± 3 | 13 ± 3 | 15 ± 4 | <0.001 | 16 ± 4 | <0.001 |
| LV lateral e′ <10 cm/s | 72 (9.0) | 37 (25) | 38 (16) | 15 (11) | <0.001 | 13 (4.8) | <0.001 |
| LA end-diastolic volume index, mL/m2 | 21 ± 6.5 | 20 ± 6.7 | 19 ± 6.8 | 23 ± 6.6 | <0.001 | 23 (6.3) | <0.001 |
| Mitral inflow E/A ratio | 1.6 ± 0.6 | 1.3 ± 0.4 | 1.4 ± 0.5 | 1.6 ± 0.5 | <0.001 | 1.6 ± 0.5 | 0.026 |
| Mitral average E/e′ ratio | 6.1 ± 2.1 | 8.2 ± 3.7 | 7.5 ± 2.9 | 6.2 ± 2.0 | <0.001 | 5.6 ± 1.4 | <0.001 |
| Tricuspid regurgitation gradient, mm Hg | 15.3 ± 6.4 | 18.5 ± 7.3 | 17.4 ± 7.2 | 14.4 ± 5.9 | <0.001 | 15.1 ± 5.7 | 0.10 |
| Diastolic dysfunction grade I, in presence of normal LVEF | 0 (0) | 1 (1.0) | 0 (0) | 1 (0.9) | 0.068 | 5 (2.0) | 0.006 |
Values are n (%) or mean ± SD.
LA = left atrium; LV = left ventricle; LVEF = left ventricular ejection fraction; other abbreviations as in Table 1.
a
3 CCS treated with anthracyclines but with missing radiotherapy exposure status could not be classified.
b
Either cyclophosphamide, ifosfamide, or vincristine without anthracyclines, mitoxantrone, or radiotherapy involving the heart region.